Tobacco Foes Hope for Treaty

To the health officials, researchers and activists attending a global anti-smoking conference here last week, an electronic ticker served as a call to arms: “Tobacco kills eight people around the world every minute,” it read. “Look how many have died since the conference began.” From Sunday night to Thursday afternoon, the tally had reached 42,000.

At the 11th World Conference on Tobacco or Health, which drew anti-smoking leaders from 130 nations, even grimmer numbers were delivered with mantra-like frequency by many speakers: Worldwide, an estimated 4 million people die annually of diseases linked with smoking. If present trends continue, tobacco-related deaths will reach 10 million annually by 2030, most of them in the developing world.

“We’re looking at something that’s absolutely apocalyptic” for public health, said Simon Chapman, a sociologist from Australia who is an expert on tobacco advertising.

No magic bullet emerged from the conference. However, participants enthusiastically touted a proposed global treaty--the Framework Convention on Tobacco Control--as the best chance for saving millions of lives.

But whether the treaty--proposed by the World Health Organization, an agency of the United Nations, and endorsed, in concept, by 192 countries--will go beyond anti-smoking platitudes sparked emotional debate all week.

For more than 4,000 participants in name tags fitted with pouches for collecting business cards, the conference was a giant networking session. Researchers presented some 2,000 abstracts of forthcoming papers on all aspects of tobacco and health. And leading health agencies and advocacy groups used the conference as a springboard for their work.

U.S. Surgeon Gen. David Satcher released the 29th in the series of surgeon general’s reports on smoking. Unlike the prior 28--all of which concerned problems linked to smoking--this one describes solutions for reducing smoking below the current U.S. rate of 25% of adults.

The World Bank and WHO issued a report on tobacco control in developing nations, calling for higher cigarette taxes as a means to cut demand and save millions of lives.

The WHO also released a scathing report, based on internal tobacco industry documents, on the industry’s clandestine use of front groups and other efforts “to discredit and impede” WHO’s attempts to discourage smoking.

In that report and in conference proceedings, international tobacco firms, led by Philip Morris Cos. and British-American Tobacco, were bashed like pinatas. But participants acknowledged that their challenge is more complicated than reining in the tobacco multinationals. Even with the liberalization of trade and investment policies, the manufacture and marketing of cigarettes in many countries is controlled by domestic monopolies, some government-owned.

Many participants hailed the importance of the damaging internal documents that have been made public through tobacco-related litigation in the United States.

The documents have had an important psychological effect, in that fear of Big Tobacco as an “impregnable” force “has really been dissipated,” said Judith Mackay, a Hong Kong-based physician who has advised WHO and the government of China on tobacco policy.

Whether the Framework Convention on Tobacco Control will be adopted--and whether it will be a feel-good statement of goals or an agreement with teeth--was a major focus of discussions all week. Formal drafting of the convention gets underway in October in Geneva, when public hearings also will be held to take statements from the tobacco industry and anti-smoking groups.

The convention could do no more than state a series of general objectives. Or, adopting a tougher stance, it could require ratifying nations to seek bans on tobacco advertising, regulations on secondhand smoke and higher cigarette taxes, among other measures.

Tobacco companies have complained of being shut out of the negotiating process. In a statement, Philip Morris said it is “committed to establish a dialogue and cooperate with” nations and groups involved in preparing the accord.

But “regrettably, in its treatment of tobacco use as an ‘epidemic’ that must be ‘controlled,’ we think the WHO presents a vision of a wholly tobacco-free society that fails to recognize tobacco consumption as a legitimate choice that adults can make, and fails to recognize the right of independent countries to make their own determinations about issues such as taxation and litigation,” the company said.

For their part, health advocates are particularly concerned about the position of the United States, with its sensitivity to sovereignty concerns and aversion to ratifying international agreements on matters of health, welfare and weapons control.

In a letter to the conference, President Clinton last week called for adoption of a “strong, effective, ratifiable agreement.” Many here saw “ratifiable” as a code word for a weak treaty that the U.S. Senate might be willing to support.

Health and Human Services Secretary Donna Shalala, who attended the conference, responded obliquely to questions about the statement, citing the Clinton administration’s “very strong position on tobacco and health.”

Many participants argued for the toughest possible agreement, even if key nations like the U.S. might be left behind.

“A weak convention will be worse than no convention,” said Elif Dagli, head of Turkey’s National Committee on Tobacco and Health, arguing that tobacco companies and their political allies will use the accord as a reference point to oppose tougher measures by individual nations.